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0 <br /> • 2io3ro\ <br /> (FOR PERMIT STAFF <br /> Intake & Approval Sheet ONLY) PERMIT# <br /> BUILDING PLANNING / <br /> Intake OK by: Date: Intake OK by: t h Assign To: .6- Date: 3/IZ/242-1 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit to Route to Other Departments <br /> Bldg I/Addn/Rem Si V £ ❑ Hold in Planning File Drawer <br /> cc Garage/ essory Struct. ize j�f- Zone 13V2 <br /> Number of Stories / Overlay/Agreement <br /> Basement �No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction C/ ` Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load /7//A Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El New System mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: { Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes LJ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IZINo Additional Notes: <br /> VALUATION CALCULATION: Total$ )o"f) <br /> Approved By: Date: .G '6, 2--ail <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: - Date:7_y/t1%� =❑Backflow Prevention for high hazard: <br /> ! ;(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: CI This Permit is Approved by Public Works <br /> 0.See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder[join With this folder for permit issuance) <br /> IN-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:Ki, t,ah Date: 3-/a li 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: '. Date: 3 1-3 ), <br />